Lethal injections are poison, not medicine [Opinion]

This May 27, 2008 file photo shows the gurney in Huntsville, where Texas' condemned are strapped down to receive a lethal dose of drugs.

Photo: Pat Sullivan, STF / AP

Texas’ preferred method for executing criminals is lethal injection with pentobarbital. The whole process has the look and feel of a medical procedure. There are protocols, medical equipment, pharmaceuticals and people in white coats. But don’t be fooled: This is not the practice of medicine.

This facade of professionalism is no accident. It becomes easier to execute people when the public regards lethal injection as a serious and sober activity — subject to the same safety oversight as a procedure at a doctor’s office. This is little more than an illusion. Any attempt to cite medical or pharmaceutical regulatory oversight in any aspect of lethal injection, including drug manufacturing, is a forgery of the truth. No pharmaceutical has “lethal injection” as a Food and Drug Administration-labeled indication. There is no medically approved way to execute someone. The result is a market of questionable sources for chemicals involved in lethal injections.

According to a recent piece by Buzzfeed News, a Houston-based pharmacy called Greenpark Compounding may be the source of pentobarbital used in Texas lethal injection executions. The shocking story reveals that Greenpark Compounding has been the subject of a number of complaints as a result of improper drug manufacturing.

They’re not the only ones. Compounding pharmacies have been in the spotlight before for bad manufacturing, most notoriously in the case of New England Compounding Center, (NECC). In 2012, NECC manufactured an injectable steroid that was later shown to be contaminated. This compounded steroid was used widely to treat patients and, as a direct result, 64 people died.

In Texas, pentobarbital is intended to be used as poison, not as medicine. Asking whether it is being prepared properly is a question better answered by the evil queen in Snow White — she of poisoned apple fame — than an authority tasked with regulating pharmacies. Greenpark Compounding may have substandard practices with respect to some of its medical pharmaceuticals, but as a maker of poison for execution, its record of success is unblemished. Yes, the inmates all die.

However, in several lethal injection executions in Texas, inmates have also been heard to declare a feeling of burning as they succumb. The Eighth Amendment of the U.S. Constitution unambiguously prohibits cruelty in the setting of punishment. Previous courts claimed there is such a thing as the normal pain of dying, and that lethal injection does not need to be 100 percent pain free to be a constitutionally valid form of punishment. That’s what the judges say. Doctors, however, have a different opinion.There is no such notion of the “normal pain” of dying in the medical field. Doctors seek to relieve all pain associated with death. Anything less than this is a treatment failure.

Pentobarbital is a drug known to be caustic. Texas injects a large quantity of this chemical into individuals to kill them. Whether it is properly assembled or improperly tainted, this chemical will likely burn upon injection.

This burning is not trivial. It occurs on the inside of the body as well as within the vein that first encounters the pentobarbital. Those watching an execution might think they’re seeing someone be killed by a chemical that induces sleep and leaves the body in pristine condition. Evidence under the skin tells a markedly different story. Autopsies of executed inmates show internal organ damage unseen by witnesses. This isn’t because pentobarbital was wrongly prepared. To the contrary, this is exactly how the chemical is supposed to work. Questions about Greenpark Pharmaceuticals’ manufacturing standards miss the point. To criticize them for failing regulatory marks is like critiquing a firing squad because its bullets weren’t properly polished.

Capital punishment is a kind of killing, whether by pharmacy or firing squad, and any attempt to obscure this simple fact sets the debate backwards. How we regard the rightness or wrongness of capital punishment requires us to own the fact of killing, no matter the method.

Zivot, M.D., is an associate professor of anesthesiology and surgery at the Emory University School of Medicine.